Cost/Benefit of Non-Operative Treatment in Adults

[LindaRacine]

Regarding the study in question - I blame a flawed design from the start - using ultra conservative methods, on an adult population, that we already know are of little value. What the heck was the point on spending money on such a study - which tells us nothing whatsoever, that wasn't already known? Complete and utter waste of research dollars.

I'm not so concerned with what benefits our surgeons. I am very concerned with what benefits patients and future generataions. Both surgical and non surgical.

The research should be fair and equitable - and the scales not financially tipped in favor of one over the other. And certainly not blinded by the past to the ignorance of present and future realities.

I'm fairly certain that this data came as a result of questions that are asked on standard questionnaires. (For example, if you've tried alternative therapies, how effective have they been?) I've never heard of or seen any questionnaire that was specifically designed to rate alternative treatment. Where did you get the notion that the study looked at "ultra conservative methods, on an adult population, that we already know are of little value."? I'm willing to bet $ that there was no targeting of specific methods.

This discussion is beyond bizarre as far as I'm concerned. Using the flawed thinking that is going on, why aren't chiropractors publishing studies on surgical methods?

[Pooka1]

I just want to caution folks at this point that some rhetorical flourishes on this thread and the rhetorical flourishes of certain blatantly counterfactual positions are starting to converge...

[Pooka1]

This discussion is beyond bizarre as far as I'm concerned. Using the flawed thinking that is going on, why aren't chiropractors publishing studies on surgical methods?

Actually, the Clear types comment routinely on surgical issues like they have training in that. Talk about bizarre.

I agree about the bizarrality of the rhetoric upthread which is an allusion to the thinking. It is scaring this little bunny.

[hdugger]

Interesting jump from no benefit in a surgeon studying CLEAR or Schroth methods to keeping alternative treatments to themselves because there's no benefit. If an alternative treatment is ever proved to be beneficial, I'm sure that most surgeons will tell their patients about it.

I'm not leaping. You said:

"zero benefit to them from finding what specific, if any, alternative treatments work"

Meaning, that if the treatment did not garner them financial gain, then there is no benefit in finding out about it. I don't think I'm misreading that. That is not, in general, how the lay public understands doctors to be evaluating the "benefit" of a treatment. The lay understanding is that the benefit of a treatment is in its effectiveness for the patient. *Not* in how it financially benefits the doctor. So, I'm asking. Is that just your personal sense? Or, since you actually work with orthopedic surgeons, is it just generally understood that they are not interesting in finding "what specific, in any, alternative treatments" work because there's no financial gain in it for them.

The patients are not to blame for their reports. The study was specifically designed to find the results that it found. And, apparently, for precisely the reasons you suggest - that they have nothing to gain from finding any other result.

For a different view on the topic, look at the study that Kevin designed, which had, as one of the criteria, that the researchers did not stand to gain financially.

[LindaRacine]

I'm not leaping. You said:

"zero benefit to them from finding what specific, if any, alternative treatments work"

Meaning, that if the treatment did not garner them financial gain, then there is no benefit in finding out about it.

No, what that means is there's no payoff for a surgeon to perform a study on a specific alternative treatment. If someone else studies it, than there would be a benefit to patients, and surgeons would tell their patients about it. I've heard plenty of surgeons tell patients that they might get some pain relief from things like chiropractic, physical therapy, and acupuncture.

The study was specifically designed to find the results that it found.

I didn't realize you were there when the study was designed as well as having the full text of the article. ;-)

[hdugger]

They are turning a blind eye to treatments that don't have a lick of evidence that they are efficacious. After decades and decades in some cases.

I think that's a different argument

You're arguing about whether other methods can reverse or stop the progression of a curve. So far, surgery is the gold standard for that. I *believe* this study only addressed pain (or, maybe I don't know my abbreviations). And, in many of the patients, just mild or moderate pain. I don't believe surgery *is* the gold standard for mild to moderate pain in adult patients. Do other, non-surgical methods, show promise for pain. Well, yes, I think they do. However *bed rest!!* would not be one of those treatments. Good lord! It's counter-indicated even for mild back problems because it *increases* pain and *slows down* recovery! (Sorry for shouting, the whole health care thing is just really getting on my nerves.)

I don't have anything against surgeons - I have a kid who is likely going under the knife (and, again, stupid health care system, on the fast train before he loses our coverage). But, that doesn't change the fact that *these* surgeons have designed a crappy study which says absolutely nothing while pretending to say something. As a scientist, that just annoys the hell out of me.

[Pooka1]

I think all surgeons would acknowledge surgery is not the best solution to pain. It is sometimes used as a last resort I imagine, though.

Are these authors surgeons?

ETA: Bridwell is for sure. Maybe the others are too, don't know.

[mamamax]

Where did you get the notion that the study looked at "ultra conservative methods, on an adult population, that we already know are of little value."? I'm willing to bet $ that there was no targeting of specific methods.

Taking a look at where the study data came from - it looks pretty obvious that referrals would have been in keeping with the kind of non surgical referrals people receive every day from such institutions - and such referrals are ultra conservative. This study however gives us little detail to go on. It was an adult population from the information posted:

RESULTS.: A total of 123 patients (111 females, 12 males) with a mean age of 53.3 (18-79) years were evaluated. In 55 scoliosis patients who received no treatment, the only significant change in HRQOL measures over the 2-year period was in SRS satisfaction subscore (0.3 points, P = 0.014)

.

This discussion is beyond bizarre as far as I'm concerned. Using the flawed thinking that is going on, why aren't chiropractors publishing studies on surgical methods?

The study is bizarre as far as I'm concerned - and useless.

[hdugger]

No, what that means is there's no payoff for a surgeon to perform a study on a specific alternative treatment. If someone else studies it, than there would be a benefit to patients, and surgeons would tell their patients about it. I've heard plenty of surgeons tell patients that they might get some pain relief from things like chiropractic, physical therapy, and acupuncture.

But, apparently, there was a benefit to them doing *this* study. What was that benefit?

I didn't realize you were there when the study was designed as well as having the full text of the article. ;-)

See above.

[Pooka1]

But, apparently, there was a benefit to them doing *this* study. What was that benefit?

I think they were being hounded by patients who don't know the score. At all. They wanted something neutral and unbiased, unlike the drivel that comes out of certain alternative hot spots.

They make no money from these treatments but still want to know if they work so they can start recommending them if they do. The audience for this paper is surgeons to give them numbers to tell patients when they come in with chiropractic stars in their eyes...

And if this is about pain then folks are screwed... surgery is known not to be the answer in most pain cases apart from scoliosis as far as I know.

[mamamax]

But, apparently, there was a benefit to them doing *this* study. What was that benefit?

A research reference in a future grant request of some kind? I don't know - just guessing, things generally boil down to finances and budgets.

[LindaRacine]

I can guarantee this was not a specific study conducted on non-surgical treatments. This probably came from the Adult Deformity Outcomes database, from a question or two about how much benefit each patient got from specific treatments (e.g., injections, physical therapy, chiropractic, etc.)

[hdugger]

I think they were being hounded by patients who don't know the score. At all. They wanted something neutral and unbiased, unlike the drivel that comes out of certain alternative hot spots.

They make no money from these treatments but still want to know if they work so they can start recommending them if they do. The audience for this paper is surgeons to give them numbers to tell patients when they come in with chiropractic stars in their eyes...

No (and, yes, I can go into the past and read minds . . . oh my God, Napoleon wants to invade Russia!)

If you want to help your patients, then you pick a few things that really seem to work (or, alternately, a few things that really don't seem to work). And you study them separately, and help guide your patients towards the good ones and away from the bad ones. But, just knowing basic math, you don't jumble together things that seem to work with things that don't seem to work because the average is always likely to be "no change." And you don't throw "bed rest" into the "treatment" category as if it were somehow different from getting no treatment at all.

[hdugger]

Are these authors surgeons?

ETA: Bridwell is for sure. Maybe the others are too, don't know.

Yes, all surgeons. One neurologic, the rest orthopedic (to the best of my knowledge)

[mamamax]

Generally speaking - I'm sure such studies are done with future patient care in mind ... along with an eye to funding and budgetary concerns. And everybody is worried about budgets today. I wonder if the facilities involved in this project, have PT departments etc attached to their centers. If so, Like many other institutions across the country - then where the money goes is a concern. I'm just saying ... there could be way more involved in this than we may see on the surface. A study such as this could be used to justify cut backs or cost saving methods.